Don’t Blame Contact Sports

Earlier this month, I wrote about Junior Seau and chronic traumatic encephalopathy (CTE), arguing that organizations like the NFL need to do more to protect players from concussions and other head trauma. But I also believe that the dangers of contact sports are often over-stated, especially in the non-sports media. Conversely, the dangers of non-contact sports are routinely under-stated.

For instance, most people consider cycling to be vanilla and safe. But in Stage 3 of last year's Giro d'Italia, Belgium's Wouter Weylandt died following a downhill crash. The day before Stage 3 of this year's Giro, the mayor of Horsens, Denmark, had a fatal heart attack during a bicycle race to celebrate the Giro's visit to his town. In Stage 3 itself, with the cyclists sprinting toward the finish at close to 40 miles per hour, a reckless move by Roberto Ferrari caused a huge crash that knocked Stage 2 winner Mark Cavendish to the street, where he was run over by another rider and toppled a dozen others, including race leader Taylor Phinney.

This year's Giro has seen a significant crash almost every time there's been a sprint finish. These guys are traveling upwards of 30 miles an hour and all they have for protection is a bike helmet. Basically, it's the equivalent of a medium-speed motorcycle crash. That's happened four times in this year's race. U.S. announcer Todd Gogulski said during Stage 7, "It's part of the game of being a professional cyclist, is getting injured."

What about something like downhill skiing? I know some fans have trouble with the distinction between contact sports like football, where collisions are deliberately part of the sport, and racing, where crashes only happen when something goes wrong. But something always goes wrong. It's ridiculous to pretend we can hold major cycling, skiing, and auto races without crashes. They are an inevitable by-product of competition. And when collisions occur in those sports, they are far more dangerous than a tackle in a football game or a punch in a boxing ring.

The National Center for Catastrophic Sport Injury Research uses the term catastrophic injury to distinguish life-threatening or permanently life-altering injuries, such as paralysis. NCCSI's data includes both direct injuries (like Weylandt's fatal crash at last year's Giro) and indirect injuries (like the mayor's heart attack, a systemic failure as a result of exertion, at this year's).

Contact sports get a reputation as dangerous because we can see the violence; high-speed collisions and blows to the head are a fundamental part of the sport. That's true. But it's only part of the story. Looking at all levels of competition (not just the NFL), at least one fatality occurs in football almost every year. But the majority of these are indirect, and have little or nothing to do with getting hit. During the past ten years there have been 29 heat stroke deaths in football. That's a huge problem, but it's not because these guys are getting tackled. From the standpoint of permanent injury and death, contact may be the least dangerous aspect of the sport. And while direct injuries are more common in contact sports, the accidental injuries in other sports are usually far more dangerous. To argue that contact sports are uniquely dangerous is simply false.

Strange as it may sound, the most dangerous sport in the U.S. is probably competitive cheerleading. Cheerleaders make up about 3% of all female high school athletes in the United States, but account for approximately 65% of their catastrophic injuries. The U.S. Consumer Product Safety Commission (CPSC) estimates that cheerleading leads to about 25,000 emergency room visits annually. In the last 20 years, at least 18 college and high school cheerleaders have died in competition. Figures from the NCAA's insurance program suggest that a cheerleader is roughly eight times as likely to suffer major injury as a college football player.

CPSC data shows that of the 25,966 cheerleading emergency room visits in 2006, over 20% of them involved head, neck, or facial injuries — including 1,070 concussions, 75 head or neck fractures, and 1,157 internal injuries. Cheerleading is not a contact sport, but accidents happen. Name a sport you think of as safe, and there are counter-examples to show it can be dangerous. How about high school girls' basketball? Over the last 30 years, NCCSI has recorded 16 fatalities, all indirect. Track and field? In 2010, a high school athlete was hit in the face by a discus, and two college pole vaulters died when they landed or bounced out of the pit area. In 2009, two high school cross-country runners died from heart and heat problems.

The numbers above are from NCCSI's 2010 report, which frankly is terrifying. Most athletes never suffer a catastrophic injury, but there's no such thing as a "safe" sport. Baseball? Head-first slides, beanings, and balls hit at the pitcher can cause head and neck injuries. Soccer? NCCSI reports, "Since 1998 there have been at least seven deaths and another 1,800 kids treated in emergency rooms because of injuries from movable soccer goals." There is also growing concern about concussions in soccer, mostly from head-to-head contact with other players or participants striking their heads on the ground or goalposts. Gymnastics? Many of the same risks as cheerleading.

I'm not trying to pretend that contact sports like football, ice hockey, boxing, and MMA can't be dangerous. Of course they can. CTE should be a serious concern for anyone involved in those sports, and this is a condition linked with limited neurological capacity, significant personality changes, and major depression. There's a lot of progress that still needs to be made in addressing head trauma and brain damage in these sports. But arguing that these activities should be banned doesn't make sense. Ultimately, modern contact sports aren't much more dangerous than non-contact sports.

Many of the most serious catastrophic injuries are indirect, things like heart failure, heat stroke, and seizure. Those aren't unique to football, or to any contact sport. Devastating accidents can happen in any event, and just because they're accidents doesn't mean they aren't part of the sport. Ultimately, the only way to guarantee no one gets hurt is not to do anything athletic, and we can all die from obesity-related problems when we turn 30.

Contact sports can be dangerous, but we need to make them safer, not get rid of them. That applies to everything we do.

Comments and Conversation

You have a very straight-forward argument that many need to hear. Well done.
I think the issue with concussions, particularly related to the NFL and the lawsuit that has more names every day, is that players were unaware of the life-long effects of concussions. And if the league was aware, but withholding information, that’s bad.
That differs from the indirect injuries in sports because I think everybody knows that accidents are a risk in skiing, cycling, and even cheerleading. Of course I was shocked to hear that cheerleading is the most dangerous sport in the US, but common sense tells us that if you lift and/or throw somebody 10, 15 or 20 feet in the air, they may fall, and that fall will hurt.
Logic doesn’t tell us that a series of mild concussions will lead to severe depression, personality disorders, and high risk of suicide. I think that’s why this is getting more media hype - it’s surprising.
For whatever reason, we are able to look at accidents and indirect injuries and label them as unfortunate and think they’ll never happen to us. We shouldn’t do that and your article is a great reminder of that.
Direct injuries leading to debilitation post-retirement is not something high schoolers had thought about when they stepped out onto the football field, but now they will and I think in a way they should. But I can also guarantee you that if I ever have a daughter, she will not be cheerleading.

May 23, 2012

Mark:

You make a good argument but miss one problem.
Which is that head shot sports like football, boxing MMA - when performed exactly as the sport is supposed to be played - are guaranteed to cause brain injury and long-term damage. These other sports don’t do that.

That’s what all the emerging science is saying. The studies just keep coming. I know because I have google alerts for CTE and traumatic brain injury.

Last week, one study came out that said that one hard head knock (from an IED blast) started the brain producing CTE and the proteins associated with Alzheimers. One hard knock.

Another study of deceased young collegiate football players found CTE in their brains, when these players had never reported a concussion.

There’s more but that’s enough. Every week or two there’s another study.

Football as played leads to CTE. Even one hard head hit. Boxing, MMA, I hate to think of the damage in those brains just from training.

Now I love football and MMA etc (I mean I love watching the knocks) but these studies are all tightening the noose around head shot sports. They’re also tightening the noose around other sports like hockey and rugby and soccer (heading the ball) where head shots also occur either accidentally or on purpose.

Sadly, the brain is much more fragile than we suspect and it looks like the writing is on the wall for head shot sports.

Finally, we all know moms are against their sons playing football and these other collision sports but when dads like Giants great Harry Carson and Kurt Warner say the same thing, the writing is definitely on the wall.

Andrew and Mark, thanks for the thoughtful comments. The growing body of research on CTE is extremely troublesome, and it’s certainly true that most football players don’t enter the sport with a full awareness of the potential consequences. This was especially true in the past, but even today many athletes either don’t understand or disregard the risks after their playing careers. It’s a huge problem.

Andrew, I agree with what you’ve written, except… I think that just as most players and fans underestimate the potential consequences of concussions, most of us underestimate both the frequency and severity of injuries in non-contact sports, and ALL of us underestimate the risks of indirect injury and over-exertion. Heart failure isn’t supposed to happen to teenagers, but it does. Few people recognize the frequency and deadliness of heat stroke. I’m sure you remember Korey Stringer. He was 27.

Mark, you’re certainly right about the frightening risks of CTE, and I wish more athletes and fans were aware of them. I do take issue with some of your comments, however:

Head injury is NOT supposed to occur in football. Tackles and blocks aren’t supposed to cause concussions. They do sometimes, but it’s an accident, not “exactly as the sport is supposed to be played”. I don’t see what makes a football player’s concussion different than a cheerleader’s or soccer player’s; the result is the same.

For that matter, what makes a boxer’s different? Concussions happen in boxing and MMA, because participants are supposed to punch each other in the head. But they also happen in cheerleading and soccer and track and field, and they aren’t any less likely to cause CTE just because they’re accidental.

Accidents happen in every sport, and some of those accidents lead to serious injury. Accidental injuries in non-contact sports cause life-altering injuries, and just because they’re accidents doesn’t make them uncommon. They happen all the time, even in activities most of us view as benign.

I don’t believe that ice hockey or tackle football has to be dangerous. CTE is not a necessary by-product of those sports. What’s needed is [1] better protective gear, [2] rules tweaks to better facilitate player safety, [3] well-trained, independent doctors on hand to diagnose and respond to head injuries, and [4] better understanding and enforcement of existing statutes. I might add, along the lines of Andrew’s suggestion, [5] much better player education, at all levels, of the risks associated with head trauma.

As far as parents opposing football, I’m afraid you’re over-simplifying. Many moms are thrilled when their children play football, and for every Harry Carson or Kurt Warner, there’s a Hines Ward or Ricky Williams. Football is the most popular professional sport in North America. It’s the most popular college sport, and the most popular high school sport. It’s not going away, and trying to ban it would be an exercise in futility. What we need to do is keep raising awareness of the risks and take action to reduce those risks as much as possible.

I’ve been tracking the research about CTE ever since Dave Duerson shot himself. I have been dealing with several of the symptoms of CTE. I had many dings and bell ringers when I played football. Now they call them concussions. I never told anyone about them, because I didn’t want to lose my starting position to someone else. The tunnel vision and ringing would always go away. No one told me I would be haunted by it when I got older. Since I’ve studied about CTE and understand that my screwed up life has been caused by my damaged brian, my life has gotten better. I try and stay more relaxed and try to think before I act. I made a website with a lot of articles about CTE. ctesupport.com One day I hope it grows into a site where people with CTE can discuss their issues and problem.

The retired NFL players are the ones bring CTE to the masses, but the unknown, not good enough to make it, guys will bring down football. Like a lot of old dinged dads, my kid will never play football

Brad - Thanks, as always, for your thoughtfulness and measured commentary. Of course I remember Korey Stringer as I’m from Minnesota. And I don’t disagree with your assessment of our underestimation of indirect injuries. I’m with you 100% that people don’t pay enough attention to these very serious situations. But they sadly never will. Think about how many people are afraid of flying, but not afraid of driving cars when obviously cars are more dangerous and claim more lives. Fears are not rational.
For whatever reason, culture dictates that indirect injuries or accidents will happen to other people. I agree this is wrong, but it is not changing and will require more than sports to change it.
Concussions are less surprising when they happen in football, hockey and MMA than when they happen in cheerleading or gymnastics. I think this is because it is a natural consequence of what happens when things go “slightly” wrong in football, hockey or MMA. When a concussion is suffered in cheerleading, something goes “drastically” wrong to our perceptions. Fans don’t see concussions as accidents but as natural consequences of contact sports. People do not view cheerleading or gymnastics concussions in the same light. I agree with you: they should, but they don’t and I don’t think they will any time soon.
Which is why the dangers of CTE are more easily hyped by the media. A story about an indirect injury that was an accident is readable for days or weeks. People will remember it, but it won’t affect their decisions. A story like Junior Seau is readable for far longer and it will affect people’s decisions.
I’m not saying this is how it should be, but this is how it is.
Thanks again. Keep up the good work.

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